ihmt conference on workforce innovation for better...

IHMT Conference on workforce innovation for better performing health systems in Europe

The WHO Global Strategy on Human Resources for Health: Workforce 2030

Lisbon, 3 May 2018

Dr Giorgio Cometto Coordinator Health Policies and Standards

Health Workforce Department, WHO

Presenter

Presentation Notes

Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States

Sources: WHR 2006; Global Health Observatory (2014 update)

“24% burden of disease, 3% global health workforce” (2004-2005 vs 2013-2014)

Global economy is projected to create around 40 million new health and social sector jobsby 20301

1 World Bank . 2 World Health Organization

High income

Upper-middle income

Lower-middle income

Low income

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Projected shortfall of 18 million health workers to achieve and sustain the SDGs and UHC2

A GLOBAL SUPPLY AND DEMAND MISMATCH

Presenter

Presentation Notes

Why are these recommendations important? Why must we act on them now? There is a global supply and demand mismatch in the health and social workforce. **Animated, click through: The World Bank projects that economic and demographic trends will create an increasing demand for around 40 million new health workers by 2030. (click) If we compare the growth in demand against the demand in low income countries, (click) we can see that the demand above current supply in lower-middle income countries is 47x that of low-income countries, (click) almost 77x in upper-middle income countries, and (click) 25x in high income countries. We can see that this demand is mostly in middle- and high- income countries and will precipitate the creation of new employment opportunities. (click) In contrast, low and lower-middle income countries – where economic demand is suppressed – have a projected shortage of 18 million health workers to achieve and sustain Universal Health Coverage and Sustainable Development Goal 3. The contrast between economic demand and a needs-based shortfall, highlights the global mismatch between need and demand in high, middle, and low income countries.

Attrition and migration

Pre-service education

Education in other fieldsSe

cond

ary

educ

atio

n

Pool of qualified health workforce

Health workforce capable and equipped to delivery quality health services

Abroad

Universal health coverage

Employed in public sector

Unemployed

Employed in private sector

Other sectors

Incentivized in public sector

Out of the labour force

Health worker production does not match needs

Inadequate skills mix, quality and capabilities Lack of decent work,

inequitable remuneration

Weak management and regulation

Education sector Labour market dynamics

Policies on production:• Infrastructure, materials, faculty• Transformative education models• Student selection and enrolment

Policies to address inflows and outflows: • Investing in decent employment • Migration• Attract unemployed health workers

Policies to address maldistribution and inefficiencies: • Improve productivity and performance• Improve skills mix composition• Retain health workers in underserved areas• Gender sensitive policies for equity

Policies to regulate the public and private sector: • Regulate dual practice

• Improve quality of training Enhance service delivery

Labour market failures

Addressing health labour markets failures

Presenter

Presentation Notes

Animated slide: Explain labour market approach, influence of education sector and labour market dynamics Multiple labour market failures are common (click through examples of these) – red boxes with crosses Examples of policies to address labour market failures (click through examples of these) – red outlined boxes at the bottom (have highlighted those relevant to skills mix and scopes of practice)

The Global Strategy on HRH: Workforce 2030Objective 1: Optimize performance, quality and impact of the health workforce through evidence-informed policies on human resources for health, contributing to healthy lives and well-being, effective universal health coverage, resilience and strengthened health systems at all levels

Milestones:1.1 By 2020, all countries will have established accreditation mechanisms for health training institutions.

1.2 By 2030, all countries will have made progress towards halving inequalities in access to a health worker.

1.3 By 2030, all countries will have made progress towards improving the course completion rates in medical, nursing and allied health professionals training institutions.

http://www.who.int/hrh/resources/pub_globstrathrh-2030/en

Presenter

Presentation Notes

Developed to accelerate progress towards UHC and the SDGs by ensuring equitable access to health workers within strengthening health systems. Presents 4 strategic objectives and a range of policy options to address health workforce challenges to progress towards universal health coverage. It was endorsed by the 69th World Health Assembly in May 2016. A resolution was adopted (Resolution WHA 69.19) which: Urges Member States to adopt the 4 strategic objectives and implement the proposed policy options Requests WHO to provide the necessary support for its implementation and monitoring, and Invites partners to engage and support in alignment with national institutional mechanisms in order to coordinate an intersectoral health workforce agenda. I would like to highlight here objective 4 which is the topic of this meeting.

http://www.who.int/hrh/resources/pub_globstrathrh-2030/en

The Global Strategy on HRH: Workforce 2030Objective 2: Align investment in human resources for health with the current and future needs of the population and health systems, taking account of labour market dynamics and education policies, to address shortages and improve distribution of health workers, so as to enable maximum improvements in health outcomes, social welfare, employment creation and economic growth

Milestones:2.1 By 2030, all countries will have made progress towards halving their dependency on foreign-trained health professionals, implementing the WHO Global Code of Practice on the International Recruitment of Health Personnel.2.2 By 2030, all bilateral and multilateral agencies will have increased synergies in official development assistance for education, employment, gender and health, in support of national health employment and economic growth priorities.2.3 By 2030, partners in the Sustainable Development Goals will have made progress to reduce barriers in access to health services by working to create, fill and sustain at least 10 million additional full-time jobs in health- and social-care sectors to address the needs of underserved populations. 2.4 By 2030, partners in the UN Sustainable Development Goals will have made progress on Goal 3c to increase health financing and the recruitment, development, training and retention of health workforce.

The Global Strategy on HRH: Workforce 2030Objective 3: Build the capacity of institutions at subnational, national, regional and global levels for effective public policy stewardship, leadership and governance of actions on human resources for health

Milestones: 3.1 By 2020, all countries will have inclusive institutional mechanisms in place to coordinate an intersectoral health workforce agenda.

3.2 By 2020, all countries will have an HRH unit with responsibility to develop and monitor policies and plans.

3.3 By 2020, all countries will have regulatory mechanisms to promote patient safety and adequate oversight of the private sector.

The Global Strategy on HRH: Workforce 2030Objective 4: Strengthen data on human resources for health for monitoring and accountability of national and regional strategies, and the Global Strategy

Milestones: 4.1 By 2020, all countries will have made progress to establish registries to track health workforce stock, education, distribution, flows, demand, capacity and remuneration.

4.2 By 2020, all countries will have made progress on sharing HRH data through national health workforce accounts and submitting core indicators to the WHO Secretariat annually.

4.3 By 2020, all bilateral and multilateral agencies will have strengthened health workforce assessment and information exchange.

INVESTMENTS TO ACHIEVE THE SDGS: ROLE OF HRH

Source: WHO 2017

The Commission :• Highlighted the benefits across the SDGs

from investments in the health workforce;

• Drew attention to the necessary reforms in health employment, education and service delivery;

• Generated political commitment and inter-sectoral action towards more and better investment in the health workforce.

The High-Level Commission on Health Employment and Economic Growth

Presenter

Presentation Notes

Launched on March 2, 2016 by the UN Secretary General Chaired by the President of France and the President of South Africa Heads of ILO, OECD, and WHO serve as Co-vice chairs 24 Commissioners: education, employment, health, labour and foreign affairs sectors of governments and international organizations health professional associations, trade unions, academia and civil society geographic and gender parity

Baumol (1967)– Growth in health sector

employment without increase in productivity could constrain economic growth (data from USA)

Hartwig (2008 and 2011)– Confirmation of Baumol

hypothesis (data from OECD countries)

Arcand et al., World Bank (In press, 2016)– larger dataset; data from low-,

middle- and high-income countries – establishes positive and

significant growth inducing effect of health sector employment; multiplier effect on other economic sectors

– magnitude of effect greater than in other recognized growth sectors

Health as a cost disease and a drag on the

economy

Health as a multiplier for inclusive economic

growth

Decent work, inclusive economic growth, UHC

Commission’s recommendations

10 recommendations 1. Job creation2. Gender equality and women's rights3. Education training and competencies4. Health service delivery and

organization5. Technology6. Crisis and humanitarian settings7. Financing and fiscal space8. Partnerships and cooperation9. International migration10.Data, information and accountability

Presenter

Presentation Notes

The first 6 recommendations are to transform the health workforce for the SDGs while the 4 last recommendations focus on how to enable the necessary change. A look at the first set of recommendations: 1. Stimulate investments in creating decent health sector jobs, particularly for women and youth, with the right skills, in the right numbers and in the right places. 2. Maximize women’s economic participation and foster their empowerment through institutionalizing their leadership, addressing gender biases and inequities in education and the health labour market, and tackling gender concerns in health reform processes. 3. Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential. 4. Reform service models concentrated on hospital care and focus instead on prevention and on the efficient provision of high-quality, affordable, integrated, community-based, people-centred primary and ambulatory care, paying special attention to underserved areas. 5. Harness the power of cost-effective information and communication technologies to enhance health education, people-centred health services and health information systems. 6. Ensure investment in the International Health Regulations core capacities, including skills development, and ensure the protection and security of all health workers and health facilities in all settings. The second set of recommendations to enable change are: 7. Raise adequate funding from domestic and international sources (public and private) and consider broad-based health financing reform to invest in the right skills, decent working conditions and an appropriate number of health workers. 8. Promote intersectoral collaboration at national, regional and international levels. Align investments to support the heatlh workforce as part of national health and education strategies and plans. 9. Advance international recognition of health workers' qualifications to optimize skills use and increase the benefits of and reduce the negative effects of health worker migration. 10. Undertake robust research and analysis of health labour markets using harmonized metrics and methodologies to strengthen accountability and action.

THANK YOU

who.int/hrh#workforce2030

Effective coverage: what it entails

workforce is AVAILABLE?

workforce is ACCESSIBLE?

workforce is ACCEPTABLE?

workforceprovides QUALITY CARE?

AVAILABILITY ACCESIBILITY ACCEPTABILITY QUALITY

• A midwife is available in or close to the community

• As part of an integrated team of professionals, lay workers and community health services

• Woman attends

• A midwife is available

• As and where needed

• Financial protection ensures no barriers to access

• Woman attends

• A midwife is available

• As and where needed

• Providing respectful care

• Woman attends• A midwife is available• As and where needed• Providing respectful care• Competent and enabled to

provide quality care.

CRUDE COVERAGE EFFECTIVE COVERAGE

Source: SoWMy 2014

Reorienting Education • Systemic mismatch between

competencies and need• Occupational stratification (gender

and SES) • Economic incentives prioritizing

narrow specialization and development of professional occupations

• Outdated, fragmented and static curricula

• Importance of faculty often neglected

Growth in health and social sector employment throughout the economic downturn

Around 42 million people across 34 countries of the Organisation for Economic Co-Operation and Development (OECD) were unemployed in May 2015, 10 million more than before the financial crisis (OECD Employment Outlook 2015)

A large and growing share of employment

A countercyclical source of employment (USA)

SOURCE: World Bank, 2014.

A countercyclical source of employment (LMIC)

Source: Human Development Report 2015: Work for Human Development

What about future employment?

Women's share of employment in the health and social sector

Women's share of employment in the economy

Source: Magar et al, WHO, based on ILOSTAT (forthcoming 2016)

What about women?

Case for investmentHealth is a leading

economic and laboursector.

67% of the health workforce are women (compared to 41% of

total employment)

1/4 of economic growth 2000 to 2011, in low- and middle-income countries,

resulted from improvements in

health.

Presenter

Presentation Notes

The first 6 recommendations are to transform the health workforce for the SDGs while the 4 last recommendations focus on how to enable the necessary change. A look at the first set of recommendations: 1. Stimulate investments in creating decent health sector jobs, particularly for women and youth, with the right skills, in the right numbers and in the right places. 2. Maximize women’s economic participation and foster their empowerment through institutionalizing their leadership, addressing gender biases and inequities in education and the health labour market, and tackling gender concerns in health reform processes. 3. Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential. 4. Reform service models concentrated on hospital care and focus instead on prevention and on the efficient provision of high-quality, affordable, integrated, community-based, people-centred primary and ambulatory care, paying special attention to underserved areas. 5. Harness the power of cost-effective information and communication technologies to enhance health education, people-centred health services and health information systems. 6. Ensure investment in the International Health Regulations core capacities, including skills development, and ensure the protection and security of all health workers and health facilities in all settings. The second set of recommendations to enable change are: 7. Raise adequate funding from domestic and international sources (public and private) and consider broad-based health financing reform to invest in the right skills, decent working conditions and an appropriate number of health workers. 8. Promote intersectoral collaboration at national, regional and international levels. Align investments to support the heatlh workforce as part of national health and education strategies and plans. 9. Advance international recognition of health workers' qualifications to optimize skills use and increase the benefits of and reduce the negative effects of health worker migration. 10. Undertake robust research and analysis of health labour markets using harmonized metrics and methodologies to strengthen accountability and action.

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